Longer, Better-Quality Patient Interaction? Yes, Please!

Physicians are turning to house calls to provide higher-quality patient care

By Megan Headley

Today’s driving trend in healthcare is to get greater levels of care into the community, whether that’s through freestanding ambulatory care centers or partnerships with pharmacies. And while telehealth might be the trendiest method for physicians to go directly to people’s homes, it’s not the only way. More healthcare systems and innovative tech-based startups are bringing healthcare into the home with old-fashioned house calls made new.

“Between new retail clinics and telemedicine options, convenient care options is an increasingly crowded landscape that at-home care competes in. However, the evidence shows that one-and-done medicine is not sustainable,” says Nick Desai, CEO and co-founder of Heal, an app-based service that describes itself as “your family doctor in your family room.” “As we demonstrate, relationship-based care can be just as convenient as any other option—and can make the difference between catching something early or not.”

In addition, at-home care may appeal to physicians looking to spend more time with patients and provide a higher level of care.

Gaining time and context

Everyone wants doctors to spend more time with their patients. Patients certainly do: One 2017 survey of nearly 2,100 patients found “greater connectivity” and more interaction to be the highest demand patients had of their physicians.

But doctors want more time, too. A 2017 survey by athenahealth of more than 1,000 physicians on its network found that 60% agreed with the statement, “My visits with patients are often too short for me to answer their questions and treat them effectively.”

And, perhaps surprisingly, regulatory authorities also want doctors to spend more time with patients. In October 2017, CMS launched its Patients Over Paperwork initiative to study how to reduce administrative burden on physicians, in response to a 2016 Annals of Internal Medicine study that found primary care physicians spend 27% of their time on clinical activities and 49% on administrative work.

Could getting out of the office and into people’s homes be the answer to this challenge? Heal thinks so. “House calls mean more time working with patients and less time navigating bureaucracy,” Desai says. “Instead of being burnt out from piles of paperwork, doctors can focus on the best-possible patient care.” The majority of Heal’s doctors are full-time employees with the company.

Desai finds that house calls give doctors extra time and extra context, both of which help them provide better care. “Heal doctors spend on average 30 minutes with a patient instead of the national average of seven minutes. Not only are they able to spend time more listening and learning about the patient’s history, but also learn about their lifestyle and environment in the home for more personalized care plans,” he says.

Andrea Pearson, chief marketing officer for Dispatch Health, a virtual and at-home provider with locations across the United States, has seen similar results. “Our advanced practice providers like the model because they spend about 45 minutes on average with patients in their homes, where they can see the environmental and social issues that contribute to a patient’s health that you never see in an ER or clinic. Providers like making a genuine connection and really helping resolve so-called social determinants of health,” she says.

Technology makes high level at-home care possible

Health systems are jumping into the fray with at-home care, but many of the companies providing these services are independent startups with a tech focus. This at-home care runs the gamut, including primary care, urgent care, and a new range of health and wellness providers.

“We provide complex acute care and treat much of what can be treated in an ER and typically more than in an urgent care,” Pearson explains. “We carry IVs, an IV formulary, a 12-lead EKG, and a CLIA-certified lab. We commonly treat dehydration, vomiting diarrhea, lacerations and skin tears, UTIs, and make fall assessments. We routinely assess and replace catheters and gastrostomy [feeding] tubes.”

For Heal, Desai adds, “Virtually everything that can be done in a primary care doctor’s office, whether primary or urgent care, can be done by a Heal doctor in the home, even labs.”

Technology offerings is one of the two elements at the core of each of these offerings (the other is personable providers—more on that below).

Dispatch Health uses a software platform that screens every patient for risks, handles logistics based on acuity and distance, and communicates accurate arrival times to patients. “The platform also gives our APPs information about the patient and their complaint and provides documentation to the patient’s primary care and handles referrals and prescriptions,” Pearson says.

“Our technology integration is what makes the Heal doctor house call business model, patient experience, and level of personalized care possible,” Desai points out. “The driving reason our doctors are able to spend a significant amount of time with patients is because we automate the office work with our own systems. It’s what makes what may be considered old-fashioned house calls efficient for the realities of our healthcare system today.”

Heal uses Health Records on iPhone, an app designed to bring together medical records from multiple providers using Epic, Cerner, athenahealth, and certain other programs. While that has benefits for patients, who can download their clinical care plan after the visit to better remember their next steps, it also gives providers valuable context before walking into an appointment.

Desai adds, “We also have the Heal Wellbe, a simple plug-in device that connects to over 120 commercial and medical-grade tracking devices. Remote monitoring puts real-time data in the hands of a doctor to enable a new level of proactive, high-touch care.”

In fact, the new age of monitoring devices is providing physicians with more accurate information than their patients can typically provide and is enabling higher-quality at-home care. In addition, technology interventions are reducing the need for readmissions and the need for hospital beds by making high-level healthcare something patients can benefit from at home.

During a 2018 Healthcare Design Conference presentation on technology trends, Mike Wood, national director of construction for Medxcel, shared a story about a friend who had recently been discharged from the hospital. The patient had been fitted with a disposable biometric monitoring device able to call the physician directly in the event of a complication. On the drive home from the hospital, the device detected an embolism in the patient’s leg. “He would have been dead before he got home,” Wood says. Yet the device was able to promptly alert the doctor, who ordered the patient to return to the hospital where he was readmitted for several days.

Devices such as VitalConnect’s single-use, disposable VitalPatch® sensor—which provides 10 hours of biosensor storage on vital signs, including heart rate, respiratory rate, skin temperature, posture, falls, and activity—are allowing more patients to heal at home and lessening the strain on hospitals.

Challenges (privacy, cost, etc.)

For patients and providers, this “new” model of at-home care requires a certain level of trust that both data and people are safe.

As far as the data is concerned, companies like Heal are using apps that connect to HIPAA-compliant, fully encrypted servers. In some regards, the medical data is simpler to manage than cost.

“Contracting with payers and others that have patient risk across cities and states presents new challenges, especially with new care models,” Pearson says. Companies like Dispatch Health put an emphasis on up-front cost transparency, due to concerns from patients that the “concierge-like” service they’re getting comes at a premium price.

“We are asked about the additional costs for what appears to be a concierge service, but visits are the price of your copay,” Desai says. “In the majority of healthcare, you’re forced to choose between convenience, affordability, and quality, and it’s natural to be skeptical when you get all of it with Heal.”

The other part of the equation is building trust with the patient. It’s for this reason that Heal Chief Medical Officer Dr. Renee Dua interviews and vets applying physicians to look not only for licensure, but also a warm personality and approachable bedside manner. “Doctors showing up to patients’ homes need to be the type of people our patients look forward to welcoming into their family living room,” Desai says.

In addition to background checks, at-home wellness provider REME looks for emotional intelligence when vetting its providers. “We check for emotional intelligence to ensure they are people with whom the client can talk and share,” explains Moaz Hamid, managing director of REME.

But trust runs both ways, and Hamid points out that trust can be a big challenge for patients and providers alike in working with at-home care services. “The biggest challenge many of our experts have reported in adapting to this new model is that going to someone’s home is something different than what they’re used to and requires a lot of trust,” he says. “They need to trust REME in order for them to know we’re mindful of where we send them, and that we’re smart about pre-vetting customers, because they need to feel comfortable before they go to someone’s home that they’ve never been before.”

The future of at-home care

Physicians and care providers not ready to commit to at-home care are testing the waters as independent contractors. “Many of the experts who provide REME services also work for themselves and other practices,” Hamid explains. “Since their days may not be filled with appointments on their own, this simply helps them gain new clients while providing a community that helps them remain connected to new revenue streams and the wellness industry.”

While pay models may still be catching up, there’s no doubt that at-home care will play a greater role in healthcare in the future. Health systems are working to drive down visits to the highest-cost hospital facilities even as aging baby boomers begin to place higher levels of strain on medical services, all while redefining the type of care they want.

Today, organization’s like Pearson’s Dispatch Health are working to ramp up investment to match the growing levels of demand. “Solving logistics, risk screening, applying technology to improve care, matching demand to capacity, and providing ongoing training to clinical teams are all things that have to be developed and constantly refined,” she says.

Hamid suggests that at-home organizations with a focus on convenience and customer service will win the battle for customer loyalty.

“In order for the industry to keep growing and to be able to bring more people into using more services that bring wellness experts to your home, we have to work together to make the experiences superior and convenient,” he says. “We can’t just stick to in-home. We, as an industry, should be open to meeting customers where they prefer. That could be a hotel room, a place of work, wherever they feel they need the service at that moment; they need to know we will go to them wherever they are. This way, if they’re more comfortable meeting in places outside the home and have great experiences, they’ll be more comfortable trusting and allowing experts in the home.”